急性重症病毒性心肌炎15例临床分析

目的总结急性重症病毒性心肌炎的诊治经验。方法对2002—2005年苏州大学附属第一医院心内科收治的15例急性重症病毒性心肌炎的临床资料进行回顾性分析。结果15例中6例出现急性左心衰,6例Ⅲ度房室传导阻滞(AVB),5例出现心源性休克,其中3例死亡,4例出现阿-斯综合征。最终治愈9例,好转3例,死亡3例。结论急性重症病毒性心肌炎病情凶险,病死率高,须及时诊断和采取有效的治疗措施,对有心源性休克者予主动脉内球囊反搏(IABP)治疗可能改善预后。     

胃肠急性穿孔B超检查

目的胃肠穿孔B超检查及临床价值．方法4例急腹症患者，其中十二指肠球部穿孔1例、回肠憩室穿孔1例，外伤引起空肠断裂2例．B超常规检查上腹部，观察肝、脾、胰显示，肠管蠕动情况，腹壁下气体移动光带，腹部包块及腹腔积液情况．结果4例均显示腹壁下、膈下有等距离、横纹状、多重反射的强回声带，称“横纹征”，并可随体位改变移动，肝、脾、胰受气体干扰显示不清．胃肠穿孔后，具有强烈刺激性的消化液刺激腹膜和肠管，引起腹膜炎、肠管麻痹、扩张积液，还引起腹腔积液．穿孔口大时，还可见有因胃肠内容物流出形成的不规则的低回声包块．结论B超检查胃肠穿孔，便捷无痛苦，同时可排除急性胰腺炎、阑尾炎等急腹症，与X线结合能明显提高胃肠穿孔诊断率．     

胃切除术后胃瘫的诊治

目的探讨胃大部切除术后残胃胃瘫综合征（PGS）的发生机制、诊断及治疗。方法对896例胃大部切除术后出现PGS患者的临床资料进行回顾性总结，探讨PGS的发生率及诊断方法。结果896例胃大部切除术患者发生PGS32例，PGS发生率为3．6％，均发生于术后3～10d；上消化道造影及胃镜检查是诊断PGS的可靠方法；32例均为非手术治愈。结论PGS的发生由多种因素引起，诊断时必须排除机械性、器质性病变；PGS采用非手术疗法均可治愈，手术治疗是禁忌证。     

急性重症病毒性心肌炎 16 例临床分析

目的总结急性重症病毒性心肌炎的诊治经验。方法对16例急性重症病毒性心肌炎的临床资料进行回顾性分析。结果16例中7例出现急性左心衰,6例出现Ⅲ度房室传导阻滞(AVB),4例出现心源性休克,3例出现阿斯综合征。治愈10例,好转3例,死亡3例。结论急性重症病毒性心肌炎病情凶险,病死率高,须及时诊断和采取有效的综合治疗措施。     

结肠镜检查及治疗并发穿孔分析

目的探讨结肠镜诊治过程中出现急性消化道穿孔的原因、诊断及预防和处理方法。方法回顾性分析2005年-2011年8例结肠镜检查致消化道穿孔病例资料。结果结肠镜并发结肠穿孔8例,诊断性肠穿孔4例,其中1例为无痛肠镜检查后穿孔,治疗性穿孔4例。当前,并发结肠穿孔主要为治疗性肠穿孔,穿孔主要位于乙状结肠及其移行区。结论结肠镜诊疗中并发肠穿孔的比例并不高,治疗取决于患者的临床状况及有无基础的肠道疾病,肠穿孔并发感染或有肠道基础疾病时,行手术治疗(开腹或腹腔镜);穿孔较小或患者一般状况好时可行内镜下治疗(金属夹)及保守治疗(禁食水加抗生素)。     

急性脑梗死67例护理体会

急性脑梗死是老年患者常见的临床急症 ,致残致死率较高。因此 ,一旦发病应积极治疗 ,在治疗的同时 ,临床护理也起着重要作用。努力做好急性脑梗死的护理 ,可提高其治疗效果。现将我们对 6 7例急性脑梗死的护理体会总结如下。临床资料 :6 7例急性脑梗死为我院 1995年 1月 - 2 0 0 0年 12月神经内科住院患者。男 5 8例 ,女 9例 ,年龄 5 3- 82岁 ,平均 6 3岁。经积极治疗和精心护理 ,结果基本治愈 2 4例 ,显效 2 7例 ,有效 8例 ,死亡 8例。死亡原因为呼衰合并肺内感染 ,应激性溃疡 ,心功能衰竭。护理体会 :1溶栓前准备。急性脑梗死发生 6小时内…     

重症急性胰腺炎并胃溃疡穿孔1例

报道1例重症急性胰腺炎并发的胃渍疡穿孔,较为罕见,临床症状体征不典型,容易误诊.此例患者通过手术获得治愈.     

妇产科疾病误诊为急性阑尾炎26例分析

［摘要］　目的　对妇产科临床疾病出现的误诊情况进行分析，以提高妇产科疾病诊断质量。方法　选取该院妇产科2011-03～2012-03收治经临床误诊为急性阑尾炎且均采取手术治疗方式的26例患者的临床资料及误诊情况进行回顾性分析。结果　所有患者均在进行阑尾炎手术治疗时证实为妇产科疾病，并在第一时间采取了相应的对症治疗和处理，包括卵巢修补、盆腔引流冲洗、宫外孕手术及卵巢囊肿切除等，经治疗后均获痊愈。结论　在临床诊断中，由于急性阑尾炎与妇产科疾病其临床症状非常相似，较容易发生误诊情况。因此，必须加强诊断过程中各种措施，详细地做好各种检查，不断总结经验，提高诊断水平，降低误诊的发生率。     

老年人粪性结肠梗阻与穿孔诊治的体会

目的 分析老年人粪性结肠梗阻与穿孔的临床特征，以提高诊治水平。方法 对1994年1月至2003年12月收治的22例老年粪性结肠梗阻与6例粪性结肠穿孔患者资料进行回顾性分析。结果 粪性结肠梗阻22例，6例分别以肠梗阻、结肠占位病变行手术治疗，16例行保守治疗，均痊愈。粪性结肠穿孔6例，分别以结肠恶性肿瘤穿孔、肠绞窄行手术治疗，穿孔部位多见于直-乙状结肠交界处，2例因感染性休克、多器官功能衰竭死亡。结论 粪性结肠梗阻患者经保守治疗多能缓解症状。粪性结肠穿孔比较罕见，缺乏特异性临床表现，误诊率和病死率高，应积极行手术治疗，切除病变肠段、行Hartmann造瘘术为首选。     

乌司他丁辅助治疗老年急腹症18例分析

乌司他丁是一种广谱酶抑制剂 ,对胰蛋白酶、弹性蛋白酶等多种水解酶具有较强的抑制作用 ,对水解酶活性亢进和炎性介质的过度升高导致的一些临床症状有较好的治疗作用。2 0 0 0年 7月～ 2 0 0 1年 7月 ,我院应用乌司他丁辅助治疗老年急腹症 18例 ,总结如下。一般资料 :选择 65岁以上老年急腹症 3 7例 ,随机分为两组 :治疗组 18例 ,男 15例 ,3例 :年龄为 65～ 83岁 ,中位数为72 .5岁。胃十二指穿孔 8例 ,结肠穿孔 7例 ,外伤性肠破裂 3例。对照组 19例 ,男 13例 ,6例 :年龄为 65～ 82岁 ,中位数为73岁。胃十二指肠穿孔 11例 ,结肠穿孔 6例 ,外…     

思他宁联合早期内镜治疗急性胆石性胰腺炎

目的 探讨应用思他宁联合早期内镜治疗急性胆石性胰腺炎(AGP)的疗效。方法 应用思他宁联合早期逆行胰胆管造影术(ERCP)、经内镜鼻胆管引流(ENBD)及经内镜乳头括约肌切开(EST)治疗AGP32例，其中轻症胰腺炎21例，重症胰腺炎11例。结果 治愈30例，2例重症胰腺炎内镜治疗后转外科手术治疗，1例术后死亡。结论 思他宁联合内镜治疗AGP是安全和有效的，对明确诊断AGP应及早应用思他宁及内镜介入治疗。     

上消化道溃疡急性穿孔96例保守治疗的体会

目的总结上消化道溃疡急性穿孔保守治疗的体会。方法对2008-01～2009-12接受保守治疗的上消化道溃疡急性穿孔患者96例的临床资料进行回顾性分析。结果全组96例上消化道溃疡急性穿孔患者全部治愈,无出现腹腔脓肿、再穿孔和死亡病例。随访半年,预后良好84例,复发10例,死亡2例。结论对于上消化道溃疡急性穿孔的治疗,在严格掌握适应证的前提下对患者采取保守治疗,可以取得满意效果。     

ERCP术中并发上消化道穿孔11例

目的:探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)并发上消化道穿孔的原因及穿孔的处理防治.方法:收集整理南京市鼓楼医院近3年(2008-08-31/2011-08-31)ERCP术中并发上消化道穿孔患者2399例,依据一定标准进行穿孔原因诊断分析,并针对患者的实际情况采取保守治疗和手术治疗相结合的方法进行穿孔治疗.结果:2399例ERCP术中发现上消化道穿孔共11例,发生率0.46%(其中食管穿孔1例,贲门口穿孔1例,十二指肠球部穿孔2例,十二指肠降部及乳头周围穿孔5例,毕Ⅱ式胃术后穿孔2例).11例上消化道穿孔中7例为保守治疗成功,4例为手术治疗成功.结论:ERCP并发上消化道穿孔原因较多,主要为医源性,处置方法是在早期发现的基础上,采取保守治疗能取得良好的效果.     

Abdominal surgical emergency in the elderly.

BACKGROUND/AIMS: Longer life expectancy has created an increasing demand for surgical care of the elderly. Abdominal surgical emergencies are potentially serious and life-threatening conditions for this group of patients. The aim of this study was to evaluate the records of elderly patients undergoing emergency surgical treatment. METHODS: A total of 181 patients aged 60 years and above who had undergone emergency surgical interventions were retrospectively analysed according to demographic features, indications for emergency surgery, postoperative clinical course and outcome. RESULTS: Sixty-one percent of the patients were male, with an average age of 70.3 (range 60-95) years. Octogenarians constituted 19% of our series. Causes of surgical emergency were acute cholecystitis (31.5%), strangulated hernia (18.2%), hollow viscus perforation (17.1%), bowel obstruction (10.5%), acute mesenteric ischaemia (9.4%), acute appendicitis (8.3%) and upper gastrointestinal haemorrhage (5%). Gallstones had been previously detected by ultrasound in 25 (45.5%) of 55 patients with acute calculous cholecystitis. Thirty (93.8%) of 32 patients were aware of their external hernias prior to incarceration. Twenty seven patients (14.4%) died in the early postoperative period, with acute mesenteric vascular occlusion being the leading cause of death: A higher mortality rate was noted in mesenteric ischaemia (76.5%), gastrointestinal bleeding (22.2%) and in perforation (19.4%) cases, being 36.8% (21/57) in patients with these three severe conditions and 4.8% (6/124) in the remaining patients. CONCLUSIONS: Acute calculous cholecystitis and external strangulated hernias, which are generally preventable, were the most common surgical emergencies. Surgical treatment of acute mesenteric ischaemia, gastrointestinal haemorrhage and peritonitis secondary to free perforation had a worse prognosis in older patients.     

Therapeutic tactics in the treatment of acute necrotizing pancreatitis

BACKGROUND/AIMS: The authors analyze the possibilities for the delay of surgery with special consideration regarding percutaneous peripancreatic drainage in the treatment of acute necrotizing pancreatitis. METHODOLOGY: In addition to intensive care therapy, 61 patients were also given antibiotic prophylaxis, and early nasojejunal enteral feeding was commenced. In a total of 22 cases where peripancreatic fluid was found, percutaneous drainage was performed. Septic necrosis, sepsis, multi-organ failure not resolving with conservative treatment, gastrointestinal perforation, and bleeding were the indications for operation. Only 9 patients underwent surgery within one week and in 40 patients delayed (more than 7 days) necrectomy was performed. Following surgery, closed omental bursa rinsing was performed. RESULTS: Five patients were cured with only conservative therapy and 7 others were cured under the influence of percutaneous drainage. In 15 patients it was possible to delay surgery using percutaneous drainage with combination of conservative treatment. A total of 39 reoperations occurred due to septic focus, bleeding, colonic necrosis and gastric perforation. The average days of nursing care was 43.3 (3-120). Mortality was 16.4% (10/61 patients). CONCLUSIONS: The number of early operations can be reduced with the use of antibiotic prophylaxis, nasojejunal feeding and percutaneous drainage.     

43例腹腔结核并发肠穿孔患者的外科治疗效果分析

目的 分析外科治疗腹腔结核致肠穿孔患者的临床情况。方法 收集河北省胸科医院2008—2016年收治的43例经手术病理确诊的腹腔结核伴肠穿孔患者,所有患者经胸部X线摄影或CT扫描检查均为可疑肺结核。描述性总结分析其术前临床表现、实验室检测及各项检查、术中探查及手术方式、术后治疗及并发症、治疗结果、随访结果等临床资料。结果 43例患者术后病理证实均存在腹腔结核,其中32例非急诊患者临床诊断明确者18例,11例急诊患者术前均未明确诊断;术中探查均存在肠穿孔,其中术前考虑单纯肠梗阻3例、肠梗阻伴肠穿孔30例(8例急诊和22例非急诊患者术前经诊断性穿刺诊断肠穿孔)、单纯肠穿孔10例。40例(93.0%)因病变范围广泛、感染严重行Ⅰ期肠切除+造瘘术,其中12例切口感染患者经切口换药、引流后治愈;8例发生肠瘘患者除2例(保守治疗、二次手术各1例,年龄均>65岁)因多脏器功能衰竭死亡外,余6例经治疗后预后良好;2例发生肠梗阻患者1例行二次手术、1例保守治疗后治愈;余18例患者造瘘术后恢复良好。2例(回盲部肿物伴穿孔1例,腹腔感染较轻1例)行回盲部切除+回结肠吻合术;1例因近回盲部出现回肠局部单一穿孔,且同时并发腹腔淋巴结结核、局部淋巴结节和穿孔部位回肠粘连,但腹腔感染较轻的患者行回肠部分切除+肠吻合术,术后无严重并发症。抗结核治疗12个月后均治愈停药。37例患者停药后随访18~24个月,4例患者失访,随访期内16例患者有间断轻微腹痛症状,其他患者一般情况均良好。结论 腹腔结核伴肠穿孔是严重的消化道结核并发症,规范的抗结核药物治疗是基础,而外科手术是有效治疗的首选方式,治疗效果良好。     

老年急性胰腺炎53例临床分析

目的探讨老年急性胰腺炎的临床特征及诊治方法。方法回顾性分析53例老年急性胰腺炎患者的临床资料。结果老年急性胰腺炎多合并有基础疾病,诱发因素主要为胆系疾病39例,占73.6%,临床主要表现为腹痛、腹胀、发热等。行急诊手术9例,术后6例发生并发症,经对症处理后均好转,死亡3例;行择期手术21例,术后发生并发症10例,经对症处理后均好转;其余23例经非手术保守治疗痊愈。结论老年急性胰腺炎主要病因为胆系疾病,临床表现多种多样,症状不典型,且合并症多,病情重,内科积极治疗有助于改善预后。     

普外科病房深部念珠菌感染标本73例分析

目的:探讨普外科病房深部真菌感染的危险因素及预防措施.方法:回顾分析普外科病房2004-01/2005-12,送检念珠菌阳性的73例患者,分析其临床资料.结果:73例患者各种标本共培养出122株念珠菌,白色念珠菌感染率最高,为45%(55/122),其次为光滑念珠茵40%(49/122)和热带念珠菌7%(8/122).73例患者念珠茵感染排在前5位的疾病依次是胃肠道恶性肿瘤、重症急性胰腺炎、非外伤性消化道穿孔、肝胆胰恶性肿瘤、腹部外伤合并肠穿孔;合并念珠菌感染病死率排在前4位的是非外伤性消化道穿孔、胃肠道恶性肿瘤、急性梗阻性胆管炎和重症急性胰腺炎.其中死亡18例,病死率为25%,除外乳腺癌,其他各疾病病死率均明显高于单纯不合并真菌感染的病种.结论:消化道手术、消化道漏、胃肠道真菌寄殖、广谱抗生素使用、高龄是普外科患者继发真菌感染的重要原因,及时合理的消化道手术、避免消化道漏、无菌操作、保护肠屏障功能是预防普外科病房深部真菌感染的重要措施.     

Serum IgA, acute phase proteins, and glycosylation of alpha 1-acid glycoprotein in ankylosing spondylitis.

Several investigators have suggested that gastrointestinal inflammation has a role in the pathogenesis of ankylosing spondylitis. To test this hypothesis markers of gastrointestinal immunostimulation, as manifested by serum IgA concentrations, were compared with serum markers of inflammation, as manifested by acute phase proteins. Serum samples from 45 unrelated Caucasian patients with ankylosing spondylitis (AS) were tested for correlation of serum IgA and six acute phase proteins: C reactive protein (CRP), alpha 1-antitrypsin, alpha 1-antichymotrypsin, caeruloplasmin, alpha 1-acid glycoprotein (AGP), and haptoglobin. Serum IgA was shown to be significantly positively correlated with four of these six acute phase proteins: CRP (r = 0.58, p less than 0.001), alpha 1-antitrypsin (r = 0.29, p less than 0.05), AGP (r = 0.61, p less than 0.01), and haptoglobin (r = 0.58, p less than 0.001), suggesting that gastrointestinal immunostimulation does have a role in the pathogenesis of inflammation in AS. In addition, the microheterogeneity of the pattern of glycosylation of AGP, expressed as reactivity coefficients, was examined. The AGP reactivity coefficient has been shown to increase in infection, remain the same in systemic lupus erythematosus, and decrease in rheumatoid arthritis. It was found that the AGP reactivity coefficient was significantly decreased in patients with AS as compared with healthy controls (p less than 0.006). As recent studies have indicated that patterns of glycosylation reflect intrahepatocellular biosynthetic processes induced by cytokines our data suggest that cytokine-hepatocellular mechanisms in AS may be similar to those occurring in rheumatoid arthritis, but different from those in systemic lupus erythematosus or infection.     

儿童胃肠道恶性肿瘤的诊断和外科治疗

目的 探讨儿童胃肠道恶性肿瘤的诊断和治疗要旨.方法 对1996年1月至2008年5月间收治的29例胃肠道恶性肿瘤患儿的病例资料,包括肿瘤的发生部位、肿瘤类型、临床表现、治疗效果及预后进行回顾性分析.结果 患儿男26例,女3例.初诊时年龄1岁10个月～14岁,中位年龄lO岁.胃肿瘤5例,包括间质瘤1例、恶性淋巴瘤2例、内胚窦瘤1例和P-J综合征恶变1例.肠道肿瘤24例,包括恶性淋巴瘤17例、结肠癌4例和阑尾类癌3例.临床主要表现为腹痛、呕吐、发热、消化道出血、消瘦等.外科并发症主要包括穿孔、内瘘、梗阻、套叠、出血.24例接受(胃)肠切除肠吻合术,5例接受活检.2例结肠癌患儿术后半年至1年复发.17例患儿存活至今,6例失访,6例死亡.结论 儿童胃肠道恶性肿瘤发病率低,临床表现无特异性,术前诊断较困难,在急腹症和胃肠道疾患的诊断中应该注意肿瘤的鉴别诊断,强调运用各种影像学和内镜技术辅助诊断;治疗采用手术切除结合化学治疗;预后与恶性肿瘤的病理本质有关.